A case of tetanus infection in an adult with a protective tetanus antibody level Kristan E. Vollman, Nicole M. Acquisto, Ryan P. Bodkin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 11 2013
x Tetanus is a bacterial infection caused by Clostridium tetani and most commonly presents as trismus or other muscle spasms. Despite the development of the tetanus toxoid vaccine, tetanus infection has not been eradicated. Additionally, while there are hypothesized protective levels of tetanus antibody, tetanus infection may still occur in properly vaccinated individuals.
Patients with cirrhosis in the ED: early predictors of infection and mortality Rafael Oliveira Ximenes, Alberto Queiroz Farias, Augusto Scalabrini Neto, Márcio Augusto Diniz, Gabriel Taricani Kubota, Maurício Menezes Aben-Athar Ivo, Caroline Gracia Plena Sol Colacique, Luiz Augusto Carneiro D'Albuquerque, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.004
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: September 10 2015
x Patients with cirrhosis have high risk of bacterial infections and cirrhosis decompensation, resulting in admission to emergency department (ED). However, there are no criteria developed in the ED to identify patients with cirrhosis with bacterial infection and with high mortality risk.
Overtreatment of gonorrhea and chlamydial infections in 2 inner-city emergency departments Colleen E. Holley, Thuy Van Pham, Heather M. Mezzadra, George C. Willis, Michael D. Witting
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 13 2015
x Infections with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are the most commonly reported sexually transmitted diseases in the United States.
Iliopsoas abscess associated with endovascular infection: an acute case of chronic Q fever Dennis G. Barten, Donné E.J. Gulikers, Marieke G.J. Versteegen, Willie P.W.L. Thimister, Quirijn de Mast, Chantal P. Bleeker-Rovers
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 30 2014
x Q fever is a zoonosis caused by Coxiella burnetii , which occurs worldwide. After acute Q fever infection, 1% to 5% of patients develop chronic Q fever. Chronic Q fever usually presents as endocarditis or endovascular infection. The diagnosis and localization of chronic Q fever are challenging, as most patients present with nonspecific symptoms. Moreover, it often occurs in patients without a known episode of acute infection.
An unusual infection of cervicofacial area caused by dental pathology: flesh-eating syndrome Serife Ozdinc, Ebru Unlu, Oya Oruc, Nese Nur User, Zeynep Karakaya
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 21 2015
x Necrotizing fasciitis (NF) of the cervicofacial area is highly rare, but physicians should be familiar with the presentation of this situation owing to the suddenness of its beginning, the rapidness of its spread, and ending with high mortality and morbidity. In this article, 5 patients with NF admitted to emergency department with dental pathology history were discussed with a review of the literature. The purpose of this case series is to raise awareness about NF of the cervicofacial area caused by dental pathologies.
Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection Karina Reyner, Alan C. Heffner, Colleen H. Karvetski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.068
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 23 2015
x Urinary tract infection (UTI) is a common cause of severe sepsis, and anatomic urologic obstruction is a recognized factor for complicated disease. We aimed to identify the incidence of urinary obstruction complicating acute septic shock and determine the characteristics and outcomes of this group.
Considerations for tetanus infection in an adult with a protective tetanus antibody level Toru Hifumi, Akihiko Yamamoto, Motohide Takahashi, Yuichi Koido, Kenya Kawakita, Yasuhiro Kuroda
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.008
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: June 12 2014
x We read with interest the article titled “A case of tetanus infection in an adult with a protective tetanus antibody level” by Vollman et al [1]. The authors reported a mild case of tetanus infection despite a markedly higher protective antibody level (8.4 IU/mL). However, there are several serious concerns raised in the study.
Response to considerations for tetanus infection in an adult with a protective tetanus antibody level Kristan E. Vollman, Nicole M. Acquisto, Ryan P. Bodkin
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.009
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: June 12 2014
x We thank Dr Hifumi et al for continuing discussion regarding our recent case report of tetanus infection despite a protective tetanus antibody level [1].
Presence of crystals is not an evidence of absence of infection Patompong Ungprasert, Quanhathai Kaewpoowat, Supawat Ratapano, Narat Srivali, Edward F. Bischof Jr.
DOI: http://dx.doi.org/10.1016/j.ajem.2012.07.020
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: September 3 2012
x Acute monoarthritis is one of the most common rheumatologic presentations. However, it is clinically difficult to distinguish between an inflamed joint due to crystal-induced arthritis and an inflamed joint due to septic arthritis. Arthrocentesis and synovial fluid analysis are used to differentiate between these 2 conditions. The presence of crystals and positive synovial fluid culture confirm the diagnosis of crystal-induced arthritis and septic arthritis, respectively. Although uncommon, these 2 arthritides can coexist, and presence of crystal does not exclude bacterial arthritis.
Secretory phospholipase A2 : a marker of infection in febrile children presenting to a pediatric ED Karim M. Mansour, Frans A. Kuypers, Tammy N. Wang, Annabeth M. Miller, Sandra K. Larkin, Claudia R. Morris
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.024
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 16 2010
x Fever is a common presenting complaint to the emergency department (ED), and the evaluation of the febrile child remains a challenging task.
Predictors of bacteremia in emergency department patients with suspected infection Maureen Chase, Richard S. Klasco, Nina R. Joyce, Michael W. Donnino, Richard E. Wolfe, Nathan I. Shapiro
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.018
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x The goal of this study is to identify clinical variables associated with bacteremia. Such data could provide a rational basis for blood culture testing in emergency department (ED) patients with suspected infection.
Community-onset febrile illness in HIV-infected adults: variable pathogens in terms of CD4 counts and transmission routes Ching-Chi Lee, Chih-Chia Hsieh, Tsung-Yu Chan, Po-Lin Chen, Chih-Hsien Chi, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.013
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 15 2014
x The objective of the study is to investigate the causes of febrile illness among HIV-infected adults visiting the emergency department (ED) of a designated hospital for HIV care in Taiwan, an area of a low HIV prevalence.
Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED Geoffrey E. Hayden, Rachel E. Tuuri, Rachel Scott, Joseph D. Losek, Aaron M. Blackshaw, Andrew J. Schoenling, Paul J. Nietert, Greg A. Hall
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.039
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: August 26 2015
x Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
The meaning of elevated troponin I levels: not always acute coronary syndromes Bryan Harvell, Nathan Henrie, Amy A. Ernst, Steven J. Weiss, Scott Oglesbee, Dusadee Sarangarm, Lorenzo Hernandez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.037
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 2 2015
x Troponin elevation can be caused by etiologies other than acute coronary syndromes (ACS). Our hypothesis was that elevated troponins occur more frequently in non-ACS cases but that ACS cases (type 1 ST-elevation myocardial infarction [STEMI] and type 1 non-STEMI [NSTEMI]) have significantly higher troponin elevations.
Imported malaria: an update Eric J. Nilles, Paul M. Arguin
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.016
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: September 12 2011
x Evidence suggests that imported malaria is a diagnostic challenge with initial misdiagnosis rates of 40% or greater. Given that prompt diagnosis and appropriate treatment are the only intervention proven to prevent progression to severe malaria and death, these figures are concerning. The purpose of this clinical review is to provide the most up-to-date and practical information on the diagnosis and treatment of imported malaria for the emergency health care provider. We highlight common pitfalls, errors, and mistakes in arriving at the correct diagnosis.
Clinical value of soluble urokinase-type plasminogen activator receptor in the diagnosis, prognosis, and therapeutic guidance of sepsis Mian Zeng, Minchan Chang, Haichong Zheng, Bin Li, Yanzhu Chen, Wanmei He, Chunrong Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.004
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: November 3 2015
x The level of soluble urokinase-type plasminogen activator receptor (suPAR) is significantly increased in sepsis. We investigated whether suPAR could be a valuable biomarker in sepsis.
What diseases are disguised as dengue? Po-An Su, Che-Kim Tan, Chien-Chin Hsu, Kuo-Tai Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: December 1 2014
x Dengue is the most common arthropod-borne viral disease and is prevalent in tropical and subtropical areas. The typical manifestations of dengue include fever, headache and myalgia, and these symptoms are commonly present in various inflammatory and infectious diseases. Therefore, the accurate diagnosis of dengue relies on laboratory studies [1]. Currently, capture enzyme-linked immunosorbent assay for dengue immunoglobulin M antibody (dengue IgM) is the most widely applied test. However, dengue IgM antibodies cross-react with other flaviviruses, and a number of non-dengue diseases have been reported to produce positive reactions in dengue serological tests [1–5].
Cytokine markers as predictors of type of respiratory infection in patients during the influenza season John Patrick Haran, Rachel Buglione-Corbett, Shan Lu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 7 2013
x The objective of this study is to characterize the cytokine response among patients presenting with an influenza-like illness who are infected with the influenza virus, a bacterial pneumonia, or another viral infection. We hypothesize that there are differences in proinflammatory and anti-inflammatory cytokines in relation to cytokines associated with the humoral response during viral and bacterial respiratory infections.
C-reactive protein as predictor of bacterial infection among patients with an influenza-like illness John Patrick Haran, Francesca Lynn Beaudoin, Selim Suner, Shan Lu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.026
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: September 3 2012
x During the influenza season patients are labeled as having an influenza-like illness (ILI) which may be either a viral or bacterial infection. We hypothesize that C-reactive protein (CRP) levels among patients with ILI diagnosed with a bacterial infection will be higher than patients diagnosed with an influenza or another viral infection.
Three cases of electrical storm in fulminant myocarditis treated by extracorporeal membrane oxygenation Weihang Hu, Lan Chen, Changwen Liu, Wei Hu, Jun Lu, Yin Zhu, Jianrong Wang, Bingwei Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.025
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: October 20 2014
x Venoarterial extracorporeal membrane oxygenation (V-A ECMO) provides effective circulation support for patients with fulminant myocarditis (FM), and there are very few reports of electrical storm (ES) occurring in FM patients due to inadequate left ventricular unloading during ECMO support. We report the treatment and outcomes of 5 FM patients who were enrolled in our study and treated with V-A ECMO support in our intensive care unit from September 2009 to May 2013. All 5 FM patients (mean age, 19.40 ± 4.80 years) were found to have inadequate left ventricular unloading and significantly reduced myocardial contractility.
Serum procalcitonin level for the prediction of severity in women with acute pyelonephritis in the ED: value of procalcitonin in acute pyelonephritis Jeong Ho Park, Jung Hee Wee, Seung Pill Choi, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.012
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x Predicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED.
Resistance of Escherichia coli urinary isolates in ED-treated patients from a community hospital Virginia H. Fleming, Bryan P. White, Robin Southwood
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.033
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: April 25 2014
x The purpose of this study is to provide resistance data for Escherichia coli isolates causing urinary tract infections in emergency department (ED) patients not requiring admission and explore if differences between this subpopulation and the hospital antibiogram exist. Differences between community-acquired urinary tract infection (CA-UTI) and health care–associated (HA-UTI) subgroups were also investigated.
Evaluation of the Mortality in Emergency Department Sepsis score combined with procalcitonin in septic patients Yongzhen Zhao, Chunsheng Li, Yumei Jia
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.008
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x To determine an effective method for predicting severity of sepsis and 28-day mortality of emergency department (ED) patients, we compared the Mortality in Emergency Department Sepsis (MEDS) score with procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) and evaluated the MEDS score combined with relevant biomarkers.
Atypical presentations of dengue disease in the elderly visiting the ED Ching-Chi Lee, Hsiang-Chin Hsu, Chia-Ming Chang, Ming-Yuan Hong, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: February 11 2013
x The objective was to compare the clinical characteristics of elderly and young adult patients with dengue in the emergency department (ED).
Fulminant dengue myocarditis complicated with profound shock and fatal outcome under intra-aortic balloon pumping support Tzu-Chieh Lin, Hsiang-Chun Lee, Wen-Hsien Lee, Ho-Ming Su, Tsung-Hsien Lin, Po-Chao Hsu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 19 2015
x Dengue is a worldwide public health problem, and its clinical severity ranges from asymptomatic infection to a fatal disease. Although cardiac involvement of dengue viral infection has been reported in the literature, there were only rare reports of fulminant dengue myocarditis, and no cardiac mechanical support was used in the reported cases. We presented a case of a 55-year-old Taiwanese woman with dengue hemorrhagic fever complicated with profound shock, acute pulmonary edema, and acute kidney injury.
A case of severe rhabdomyolysis with minor trauma: Is sickle cell trait to blame? Paul Krieger, Nathan Zapolsky, Stephen J. Lowery
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.035
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 18 2015
x A 37-year-old man with a past medical history of sickle cell trait (SCT) presented to our emergency department (ED) complaining of upper abdominal pain and bilateral shoulder pain, following an assault the prior evening. He reported being pinned on his back with knees on his chest, and repeated punching to his stomach. Physical exam revealed mild tachycardia and diffuse tenderness to palpation of the abdomen, without guarding, rebound, induration, or external signs of trauma. Bilaterally his shoulder exam revealed limited range of motion secondary to pain and tenderness over the trapezius muscles.
Field performance of clinical case definitions for influenza screening during the 2009 pandemic Shey-Ying Chen, Yee-Chun Chen, Wen-Chu Chiang, Hsiang-Chi Kung, Chwan-Chuen King, Mei-Shu Lai, Wei-Chu Chie, Shyr-Chyr Chen, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.016
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x The aim of this study was to assess the performance of 3 different influenza-like illness (ILI) case definitions, adopted by the European (European-CDC), USA (USA-CDC), and Taiwan Centers for Disease Prevention and Control (Taiwan-CDC), as screening tools for influenza during the 2009 H1N1 pandemic.
Methicillin-resistant Staphylococcus aureus colonization is not associated with higher rate of admission to pediatric intensive care unit Mohammed Naeem, Esam Al Banyan, Sardar Tanvir Sindhu
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.033
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x Methicillin-resistant Staphylococcus aureus (MRSA) colonization is consistently rising. The question whether the MRSA colonization places the patients at higher risk, requiring higher levels of care when being admitted, has never been studied. We conducted this study to determine the impact of MRSA colonization status on the required level of care upon admission to hospital.
Rhabdomyolysis as presenting feature of acute HIV-1 seroconversion in a pediatric patient Jason Gagnon, Harold Katner, S. Brent Core, Jean Dozier, Chintan Patel, Chanty Davis
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.031
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: August 29 2015
x Acute rhabdomyolysis is a rare phenomenon in the emergency setting almost exclusively associated with trauma, drugs, and recent upper respiratory and gastrointestinal infection. Rare reports in the literature have highlighted adult patients presenting with rhabdomyolysis as 1 component in a constellation of symptoms in acute HIV-1 seroconversion; however, there are few reports of rhabdomyolysis as the sole presenting symptom. This case highlights the importance of investigating HIV and other sexually transmitted diseases in pediatric cases of rhabdomyolysis in the emergency care setting.
Fluid balance in sepsis and septic shock as a determining factor of mortality Josep-Maria Sirvent, Cristina Ferri, Anna Baró, Cristina Murcia, Carolina Lorencio
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.016
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: November 19 2014
x The objective was to assess whether fluid balance had a determinant impact on mortality rate in a cohort of critically ill patients with severe sepsis or septic shock.
d -dimer is a significant prognostic factor in patients with suspected infection and sepsisJoaquín R. Rodelo, Gisela De la Rosa, Martha L. Valencia, Sigifredo Ospina, Clara M. Arango, Carlos I. Gómez, Alex García, Edilberto Nuñez, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.033
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: July 16 2012
x The aim of the study was to determine whether C-reactive protein (CRP), procalcitonin (PCT), and d -dimer (DD) are markers of mortality in patients admitted to the emergency department (ED) with suspected infection and sepsis.
The critical care literature 2009 Michael E. Winters, Tsuyoshi Mitarai, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.009
The American Journal of Emergency Medicine , Vol. 29 , Issue 5 ,
Published online: May 3 2010
x Marchick MR, Kline JA, Jones AE. The significance of non-sustained hypotension in emergency department patients with sepsis. Intensive Care Med 2009;35:1261-1264.
Newly designed delta neutrophil index–to–serum albumin ratio prognosis of early mortality in severe sepsis Yoon Jung Hwang, Sung Phil Chung, Yoo Seok Park, Hyun Soo Chung, Hye Sun Lee, Jong Woo Park, Jong Wook Lee, Jung Hwa Hong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.012
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 13 2015
x We evaluated the ratio of delta neutrophil index (DNI) to albumin (A) in patients receiving early goal-directed therapy (EGDT) to determine the prognostic significance of the DNI/A ratio as a marker of early mortality in critically ill patients with suspected sepsis.
Concurrent infectious mononucleosis and community-associated methicillin-resistant Staphylococcus aureus bacteremia Li Jun Wang, Xiao Qin Du, Eric Nyirimigabo, Song Tao Shou
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.033
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 25 2013
x It is rare to see a concurrent infection with infectious mononucleosis and community-associated methicillin-resistant Staphylococcus aureus in Tianjin, China. Until now, there is still no any single recorded case of concurrent infectious mononucleosis and community-associated methicillin-resistant Staphylococcus aureus bacteremia.
Diagnostic and prognostic value of myeloid-related protein complex 8/14 for sepsis Shanglan Gao, Yan Yang, Yun Fu, Weidong Guo, Guowei Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.025
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 17 2015
x The objective of this study is to evaluate the diagnostic and prognostic value of myeloid-related protein complex 8/14 (MRP8/14) in septic patients in intensive care units.
The role of autonomic nervous system function in hypothermia-mediated sepsis protection Yun-Te Chang, Shue-Ren Wann, Jung-Shun Tsai, Chih-Hsiang Kao, Po-Tsang Lee, Neng-Chyan Huang, Cheng-Chang Yen, Mu-Shun Huang, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.028
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x The objective of this study is to determine whether hypothermia will lessen decreases in heart rate variability and improve outcome in a rat model of sepsis.
Clinical factors in predicting acute renal failure caused by rhabdomyolysis in the ED Chun-Yu Chen, Yan-Ren Lin, Lu-Lu Zhao, Wen-Chieh Yang, Yu-Jun Chang, Han-Ping Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.047
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x This study aimed to determine the clinical factors in predicting acute renal failure (ARF) in rhabdomyolysis and investigate the potential risk of renal replacement therapy (RRT).
Antibiotics for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: the challenge of outpatient therapy Amy J. Pate, Reno Giovonni Terribilini, Farzaneh Ghobadi, Alaleh Azhir, Andre Barber, Julie Marie Pearson, Hossein Kalantari, Getaw W. Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 14 2013
x Methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming increasingly prevalent in both community and hospital settings. Certain strains are notorious for causing skin and soft tissue infections in patients with no established risk factors. In this article, we report our findings on the dynamic antibiotic resistance pattern of MRSA and outpatient prescription trend for skin and soft tissue infections within our community.
Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis Aaron M. Burnett, Christopher P. Anderson, Michael D. Zwank
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: October 26 2011
x The aim of this study was to determine the rates of laboratory confirmed gonorrhea (GC) and chlamydia (CT) in emergency department (ED) patients with pelvic inflammatory disease (PID) and cervicitis who were diagnosed clinically and treated empirically. A secondary goal examines which clinical criteria were present in patients with PID testing positive for GC/CT.
Venous lactate in predicting the need for intensive care unit and mortality among nonelderly sepsis patients with stable hemodynamic Khrongwong Musikatavorn, Saranpat Thepnimitra, Atthasit Komindr, Patima Puttaphaisan, Dhanadol Rojanasarntikul
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 9 2015
x Our study aims to investigate the role of initial venous lactate in predicting the probability of clinical deterioration and 30-day mortality in nonelderly sepsis patients with acute infections, without hemodynamic shock.
False positivity of monospot test in an immunocompetent elderly woman with acute cytomegalovirus infection Natanong Thamcharoen, Suthanya Sornprom, Nitipong Permpalung, Charles L. Hyman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 21 2015
x A 75-year-old woman presented with altered mental status, septic picture, and influenza-like symptoms. Initial investigations revealed atypical lymphocytosis, thrombocytopenia, elevated liver enzymes, and a positive monospot test result. Further investigation showed the Epstein-Barr virus viral capsid antibody IgM/IgG and Epstein-Barr virus DNA by polymerase chain reaction to be negative; however, interestingly her cytomegalovirus (CMV) IgM and IgG were positive, suggesting that her mononucleosis-like syndrome was due to acute CMV infection.
Prognostic factors of Streptococcus pneumoniae infection in adults Toru Hifumi, Seitaro Fujishima, Takayuki Abe, Nobuaki Kiriu, Junichi Inoue, Hiroshi Kato, Yuichi Koido, Kenya Kawakita, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.025
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 15 2015
x The mortality of severe sepsis has markedly decreased since the implementation of the Surviving Sepsis Campaign guidelines. The next logical step is to examine the necessity of individualized management guidelines for targeted therapy against specific bacteria. Streptococcus pneumoniae is the leading cause of community-acquired severe sepsis; however, little is known regarding the prognostic factors in adult patients with S pneumoniae sepsis. We aimed to identify prognostic factors in patients with S pneumoniae sepsis and to explore a subgroup of patients at high risk for death with detailed Sequential Organ Failure Assessment (SOFA) score analysis.
A comparison of routine, opt-out HIV screening with the expected yield from physician-directed HIV testing in the ED Matthew E. Prekker, Brandi M. Gary, Roma Patel, Travis Olives, Brian Driver, Stephen J. Dunlop, James R. Miner, Sarah Gordon, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.057
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: January 2 2015
x The Centers for Disease Control and Prevention recommends routine opt-out HIV screening in health care settings. Our goal was to evaluate the feasibility and yield of this strategy in the emergency department (ED) and to compare it to the expected yield of physician-directed testing.
Hepatitis C virus infection in the 1945-1965 birth cohort (baby boomers) in a large urban ED Waridibo E. Allison, William Chiang, Ada Rubin, Lauren O'Donnell, Miguel A. Saldivar, Michael Maurantonio, Jeffrey Dela Cruz, Svetlana Duvidovich, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.072
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 28 2015
x The US Preventive Services Task Force recommends one-time screening of the 1945-1965 birth cohort (baby boomers) for hepatitis C (HCV) infection. New York State legislation mandates screening of baby boomers for HCV in most patient care settings except the emergency department (ED). This cross-sectional study explores baby boomer knowledge of HCV, prevalence of HCV infection, and linkage to care from a large urban ED.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00518-9
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published in issue: November 2012
Spontaneous septic arthritis in a patient without trauma, coinfection, or immunosuppression Peter L. Griffin, Gregory D. Griffin, Erin L. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 23 2013
x Septic arthritis is a rare infection, most often affecting the knee and hip [1]. Infections are often secondary to joint repair or replacement surgery, systemic infection, or intravenous recreational drug use [1,2]. Diabetes, rheumatoid arthritis, hepatic dysfunction, and immunosuppression are common risk factors [1,2]. Although septic arthritis can occur spontaneously, such occurrences are rare. We report a case of a previously healthy 54-year-old woman with no known risk factors presenting to a freestanding emergency department with 5 days of shoulder pain.
Factors associated with pneumonia in post–cardiac arrest patients receiving therapeutic hypothermia Jae-Hyug Woo, Yong Su Lim, Hyuk Jun Yang, Won Bin Park, Jin Seong Cho, Jin Joo Kim, Sung Youl Hyun, Gun Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.035
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 22 2013
x The aim of this study is to investigate risk factors associated with the development of pneumonia during the first 7 days of admission in survivors of cardiac arrest receiving therapeutic hypothermia.
Lower mortality in sepsis patients admitted through the ED vs direct admission Emilie S. Powell, Rahul K. Khare, D. Mark Courtney, Joe Feinglass
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.011
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 28 2011
x Early aggressive resuscitation in patients with severe sepsis decreases mortality but requires extensive time and resources. This study analyzes if patients with sepsis admitted through the emergency department (ED) have lower inpatient mortality than do patients admitted directly to the hospital.
Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit Kathryn A. Volz, Louisa Canham, Emily Kaplan, Leon D. Sanchez, Nathan I. Shapiro, Shamai A. Grossman
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment.
Extracorporeal membrane oxygenation for refractory, life-threatening, and herpes simplex virus 1–induced acute respiratory distress syndrome. Our experience and literature review Massimo Bonacchi, Gabriella Di Lascio, Guy Harmelin, Andrea Pasquini, Adriano Peris, Guido Sani
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.011
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 13 2011
x We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. Pneumonia caused by HSV1 is a rare finding in immunocompetent individuals; it occurs more often in immunosuppressed and ventilated patients. It is a severe illness; therefore, early diagnosis and initiation of treatment are imperative.
Urinalysis is an inadequate screen for rhabdomyolysis Sameir A. Alhadi, Rawnica Ruegner, Brandy Snowden, Gregory W. Hendey
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.045
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 6 2013
x Hematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is indicative of rhabdomyolysis. We determined the sensitivity of this classic urinalysis (UA) finding in the diagnosis of rhabdomyolysis.
Severe dengue with massive pleural effusion requiring urgent intercostal chest tube drainage: a case report Afzal Azim, Jyoti N. Sahoo, Arvind K. Baronia, Mohan Gurjar, Ratendra K. Singh, Banani Poddar, Armin Ahmed, Piyush Garg, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.024
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: February 28 2011
x Dengue is one of the most common mosquito-borne infection affecting more than 50 million people worldwide annually. Most common causes for dengue-associated mortality are shock, bleeding, and respiratory failure.
Catamenial diabetic ketoacidosis—a diagnostic dilemma in ED Nayer Jamshed, Bharatraj Banavaliker, Praveen Aggarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.038
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 29 2012
x Diabetic ketoacidosis (DKA) is a frequent medical emergency. The most common precipitating events are absolute or relative deficiency of insulin, infection, and noncompliance with medication. We describe a 32-year-old lady with type 1 diabetes mellitus in whom DKA was precipitated 1 to 2 days before her menstrual periods resulting in repeated admissions to hospital. Menstruation may precipitate DKA. Emergency physicians must keep this in mind if no other precipitating event can be found in a patient with DKA.
Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program Yu-Hsiang Hsieh, Gabor D. Kelen, Kaylin J. Beck, Chadd K. Kraus, Judy B. Shahan, Oliver B. Laeyendecker, Thomas C. Quinn, Richard E. Rothman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.002
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 8 2015
x To investigate the prevalence of undiagnosed HIV infections in an emergency department (ED) with an established screening program.
Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2 patients with fulminant myocarditis Weihang Hu, Changwen Liu, Lan Chen, Wei Hu, Jun Lu, Yin Zhu, Jianrong Wang, Bingwei Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 29 2014
x Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective treatment for fulminant myocarditis (FM). However, VA-ECMO has a limited ability to facilitate left ventricular unloading. Therefore, increased afterload is still a significant concern, especially for those with diffuse myocardial damage and serious left ventricular dysfunction. To our knowledge, there is no report concerning the use of these therapies to treat FM in China. This study investigates the efficacy of using intraaortic balloon counterpulsation to facilitate left ventricular unloading in patients treated with VA-ECMO.
Author’s reply re: Sepsis mortality at Kaiser Permanente Northern California William Durston
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.023
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: August 1 2014
x I appreciate the opportunity to respond to Morehouse et al criticisms of my correspondence
[1] in which I presented data showing that the sharp reduction in sepsis mortality claimed by Kaiser Permanente (KP) after adoption of a regional early goal-directed therapy (EGDT) sepsis protocol
[2-5], modeled after the protocol published by Rivers et al
[6], was more likely to be due to a change in the definition of sepsis than to real improvements in sepsis care. I noted that adoption of the protocol was actually associated with an increase in the number of patients dying of sepsis per 1000 hospital admissions for all causes, suggesting possible harm from some elements of the protocol.
Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era Kristin Ratnayake, Andrew J. Davis, Lance Brown, Timothy P. Young
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.011
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 16 2015
x We sought to describe the causative organisms, bones involved, and complications in cases of pediatric osteomyelitis in the postvaccine age and in the era of increasing infection with community-associated methicillin-resistant Staphylococcus aureus (MRSA).
Synthetic cannabinoid hyperemesis resulting in rhabdomyolysis and acute renal failure Jacqueline R. Argamany, Kelly R. Reveles, Bryson Duhon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.051
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: September 7 2015
x Synthetic cannabinoid usage has increased in the past decade. Concurrently, emergency management of associated adverse effects due to synthetic cannabinoid usage has also risen. Reported toxicities include psychosis, seizures, cardiotoxicity, acute kidney injury, and death. While cannabis was first described as a cause of acute hyperemesis in 2004, a more recent case series also describes the association between cannabinoid hyperemesis and risk of acute renal failure. Synthetic cannabinoids have also been reported to cause acute hyperemesis and acute renal failure; however, the risk of rhabdomyolysis-induced renal failure has yet to be elucidated.
Emergency management of community-acquired bacterial pneumonia: what is new since the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines Gregory J. Moran, Richard E. Rothman, Gregory A. Volturo
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Community-acquired pneumonia (CAP) is a major health problem in the United States and is associated with substantial morbidity, mortality, and health care costs. Patients with CAP commonly present to emergency departments where physicians must make critical decisions regarding diagnosis and management of pneumonia in a timely fashion, with emphasis on efficient and cost-effective diagnostic choices, consideration of emerging antimicrobial resistance, timely initiation of antibiotics, and appropriate site-of-care decisions.
End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis Christopher L. Hunter, Salvatore Silvestri, Matthew Dean, Jay L. Falk, Linda Papa
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.034
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: August 6 2012
x Exhaled end-tidal carbon dioxide (Etco 2 ) concentration is associated with lactate levels in febrile patients. We assessed the association of Etco 2 with mortality and lactate levels in patients with suspected sepsis.
Right lower quadrant abdominal pain, fever, and hypotension: an atypical presentation of meningococcemia Ryan P. Austin, Adam G. Field, William M. Beer
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 17 2015
x A previously healthy, 33-year-old man presented to our emergency department complaining of right lower quadrant abdominal pain with anorexia, nausea, vomiting, diarrhea, and fever. Physical examination revealed hypotension, with rebound tenderness in the right lower quadrant. A computed tomography scan of the abdomen and pelvis revealed a normal appendix but showed findings suggestive of inflammation within the retroperitoneum. The initial suspected diagnosis was appendicitis with dehydration, but after not responding to initial fluid resuscitation and obtaining a computed tomography scan with only retroperitoneal inflammation, other etiologies of sepsis were considered.
Acute neck infections in children: who is likely to undergo surgical drainage? Michael W. Sauer, Sujit Sharma, Daniel A. Hirsh, Harold K. Simon, Beesan S. Agha, Jesse J. Sturm
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.043
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: May 15 2013
x Superficial neck infections including lymphadenitis and abscesses are commonly encountered in pediatric emergency departments (PEDs). It is often unclear which patients are likely to develop an abscess that necessitates surgical drainage. In evaluating these patients, computed tomography (CT) and ultrasound are often used to identify/confirm abscess formation. The criteria for determining the need for imaging studies are not well defined.
Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED Ching-Chi Lee, Feng-Yuan Chu, Wen-Chien Ko, Chih-Hsien Chi
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.028
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: August 2 2014
x The objective of this study is to analyze the differences in clinical presentation and outcome of community-onset bacteremia between human immunodeficiency virus (HIV)-infected adults and HIV-uninfected adults visiting the emergency department (ED).
The characteristics and prognostic predictors of unplanned hospital admission within 72 hours after ED discharge Shih-Yu Cheng, Hui-Ting Wang, Chi-Wei Lee, Tsung-Cheng Tsai, Chi-Wei Hung, Kuan-Han Wu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.004
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 11 2013
x The aims of this study were (1) to identify the characteristics of patients who return to the emergency department (ED) within 72 hours and are admitted to the hospital and (2) to identify the characteristics and predictors of in-hospital mortality subgroup.
Injury and illness sustained by human competitors in the 2010 Iditarod Sled Dog Race James W. Gallea, George L. Higgins III, Carl A. Germann, Tania D. Strout
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: February 26 2014
x Alaska's 1049-mile Iditarod Trail Sled Dog Race is the world's longest sled dog race and the flagship event in the sport of sled dog racing. Race conditions are typically harsh. Physicians are not officially enlisted to care for human competitors. Instead, medical needs are met through an informal system of volunteers, local health care providers, and a fleet of bush planes. The goals of this study were to identify the types of human injury and illness experienced and the methods by which these conditions are treated.
Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care Chien-Cheng Huang, Shu-Chun Kuo, Tsair-Wei Chien, Hung-Jung Lin, How-Ran Guo, Wei-Lung Chen, Jiann-Hwa Chen, Su-Hen Chang, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.010
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: April 22 2013
x We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups.
Acute kidney injury and thrombocytopenic fever—consider the infrequent causes Christian S. Haas, Walter Lehne, Philip Muck, Anja Boehm, Jan Rupp, Juergen Steinhoff, Hendrik Lehnert
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.007
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published in issue: February 2013
x Acute kidney injury (AKI), fever, hepatosplenomegaly, and thrombocytopenia are characteristics of Hantavirus infections and leptospirosis, both worldwide zoonoses. Although AKI is usually the result of tubulointerstitial nephritis, glomerular damage with significant albuminuria and hematuria may be noted in both entities. Although Hantavirus infections are endemic in Western Europe and the United States, leptospirosis is predominantly seen in parts of South America and Asia. We here report 3 cases of thrombocytopenic fever and AKI presenting within several months in Northern Germany with initially suspected Hantavirus infection.
Pediatric abscess characteristics associated with hospital admission from the ED Michael W. Sauer, Daniel A. Hirsh, Harold K. Simon, Shervin A. Kharazmi, Jesse J. Sturm
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.015
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 16 2010
x To determine the characteristics of pediatric soft tissue abscesses that result in hospital admission.
Pitfalls in using serum C-reactive protein to predict bacteremia in febrile adults in the ED Ching-Chi Lee, Ming-Yuan Hong, Nan-Yao Lee, Po-Lin Chen, Chia-Ming Chang, Wen-Chien Ko
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: April 25 2011
x The diagnostic performance of serum C-reactive protein (CRP) in prediction of bacteremia among febrile patients visiting an emergency department (ED) was analyzed.
Comment on: “Atypical presentations of dengue disease in the elderly visiting the ED” Subhash C. Arya, Nirmala Agarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.057
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 11 2013
x To the Editor:
Point-of-care ultrasound differentiates pyomyositis from cellulitis Allison Sauler, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.064
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 29 2014
x Pyomyositis (PM) is an infection of skeletal muscle, often associated with an abscess. Patients typically have predisposing risk factors or are immune compromised. The disease is often misdiagnosed, mistreated, and goes undetected until late in the patient's clinical course. We present a case of a patient without obvious predisposing risk factors who complained of right thigh pain, swelling, redness, and fevers for 4 days. Point-of-care ultrasound revealed muscle edema and subcutaneous emphysema without signs of an overlying cellulitis.
Epiglottic abscess Jason K. Hsieh, Michael P. Phelan, Grace Wu, Aliye Bricker, Samantha Anne
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.036
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 21 2014
x Epiglottic abscess is an uncommon complication of acute epiglottitis that occurs almost exclusively in adults. Because it is a potentially life-threatening condition, prompt diagnosis and appropriate treatment are required. Keys to successful management include assessing the likelihood of the need to secure the airway and potential for airway compromise during intubation, as well as drainage and culture of abscess and institution of appropriate and timely antibiotic therapy. If the patient is considered at risk for complete airway obstruction, prompt institution of a pathway to securing the airway is crucial, including stabilization, notification of surgical and anesthesia teams, and safe transfer to the operating room.
Derivation of a clinical prediction rule to predict hospitalization for influenza in EDs Kuan-Fu Chen, Yu-Hsiang Hsieh, Charlotte A. Gaydos, Alexandra Valsamakis, Richard E. Rothman
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.010
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Early, rapid, and accurate identification of those patients who have severe influenza is important for emergency physicians. Influenza viral load, which has been proposed as a predictor of severe influenza, could be useful in facilitating decision making of resource use. We aimed to derive a clinical prediction rule to indicate probability for inpatient hospitalization for patients with influenza, which includes influenza viral load in addition to other clinical information commonly collected in the emergency department (ED).
Effect of mild hypothermia on the increase of CD11b+ Gr-1+ myeloid-derived suppressor cells induced by lipopolysaccharide in a mouse model of sepsis Xiaoshuang Li, Li Liu, Feifei Luo, Li Gui, Dazhi Fan, Qilian Xie
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.008
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 16 2015
x This study aimed to investigate the influence of mild hypothermia on the number of CD11b+ Gr-1+ myeloid-derived suppressor cells (MDSCs) induced by lipopolysaccharide (LPS) injection in mice with sepsis.
Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED Yu-Hsiang Hsieh, Jason S. Haukoos, Richard E. Rothman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.043
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: March 6 2014
x We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence.
The prognostic role of non-critical lactate levels for in-hospital survival time among ED patients with sepsis Adam R. Aluisio, Ashika Jain, Bonny J. Baron, Saman Sarraf, Richard Sinert, Eric Legome, Shahriar Zehtabchi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.006
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 12 2015
x This study describes emergency department (ED) sepsis patients with non-critical serum venous lactate (LAC) levels (LAC <
HIV-positive patient with herpes zoster: a manifestation of the immune reconstitution inflammatory syndrome Nancy Lutwak, Curt Dill
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 3 2010
x Herpes zoster is a common illness that can lead to serious morbidity. There is now evidence that HIV-infected patients who have been treated with antiretroviral therapy are at greater risk of developing herpes zoster not when they are severely immunocompromised but, paradoxically, when their immune system is recovering. This is a manifestation of the immune reconstitution inflammatory syndrome. The objectives of this report are to (1) inform health care providers that HIV-infected patients may develop multiple infectious, autoimmune, and oncological manifestations after treatment with antiretroviral medication, as they have immune system reconstitution, and (2) discuss herpes zoster, one of the possible manifestations.
Multimodality diagnosis and surgical management of prosthetic valve endocarditis complicated with perivalvular abscess formation Mahmut Yesin, Macit Kalçık, Mustafa Ozan Gürsoy, Süleyman Karakoyun, Emrah Bayam, Mehmet Altuğ Tuncer, Mehmet Özkan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 19 2015
x Periannular extension of infection is a rare but potentially fatal complication of infective endocarditis. The accurate detection and delineation of periannular complications are crucial in patient management, which may also provide guidance for surgical interventions. Potential complications from a periannular extension of infective endocarditis include periannular abscess, pseudo-aneurysm formation, and subsequent development of aortocavitary fistula. Here, we present a case of a 46-year-old man with prosthetic aortic valve endocarditis complicated with perivalvular abscess formation that was managed with aortic homograft implantation.
Accompanying mild hypothermia significantly improved the prognosis of septic mice than artificial mild hypothermia Xiao-shuang Li, Li Liu, Yu-lian Jin, Fei-fei Luo, Lin Li, Jingfeng Zhu, Qilian Xie
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.003
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: August 5 2015
x Some patients with sepsis are found with accompanying mild hypothermia (ACMH); however, the effects of ACMH on the patients with sepsis are poorly understood.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00516-X
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published in issue: November 2011
Takotsubo cardiomyopathy, sepsis and clinical outcome: does gender matter? Fabio Fabbian, Alfredo De Giorgi, Ruana Tiseo, Benedetta Boari, Raffaella Salmi, Fulvia Signani, Beatrice Zucchi, Roberto Manfredini
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: June 17 2015
x Infections and sepsis are important causes of cardiomyopathy, since they can affect ventricular function, systolic blood pressure, circulating volume and vessel tone, and so increasing mortality rate [1]. Among cardiomyopathies, Takotsubo cardiomyopathy (TTC) represents an uncommon clinical condition characterized by a clinical picture similar to that of acute myocardial infarction [2] but with precise criteria for diagnosis [3]. It involves 1.7–2.2% of patients with suspected acute coronary syndrome and is considered a typical gender-oriented disease, affecting mostly post-menopausal women following intense emotional or physical stress [4], including infections [5].
ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study Sion Jo, Taeoh Jeong, Young Ho Jin, Jae Baek Lee, Jaechol Yoon, Boyoung Park
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.004
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 6 2015
x Adverse effects of emergency department (ED) crowding among critically ill patients are not well known.
Unusual cause of neck pain: septic arthritis of a cervical facet Jaime L. Jones, Amy A. Ernst
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.041
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 2 2012
x Neck pain is a common cause for presentation to an emergency department. Most causes are benign and often secondary to arthritis or injuries. We present a case of septic cervical facet arthritis, a very rare cause of neck pain. The clinical presentation of septic cervical facet arthritis includes fever, neck pain that is often unilateral that is worse with movement, nerve root symptoms, and radiation of pain to the shoulder. Consequences may be severe and include joint destruction and infection progression.
Diabetic ketoacidosis as the initial presentation of hyperthyroidism Chao-Yen Huang, Wei-Lung Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.065
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 29 2015
x Abdominal pain is a common chief complaint that encompasses a broad differential diagnosis at emergency department (ED), ranging from general discomfort to life-threatening disease. Abdominal pain induced by a metabolic disorder should also be considered. Diabetic ketoacidosis (DKA) is a common complication of new-onset type 1 diabetes mellitus in young patients. Although DKA that presented to the ED with complaint of abdominal pain is not uncommon, it is precipitated by hyperthyroidism, which is rare and more complicated.
Predicting tularemia with clinical, laboratory and demographical findings in the ED Derya Yapar, Ali Kemal Erenler, Özlem Terzi, Özlem Akdoğan, Yasemin Ece, Nurcan Baykam
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.034
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 24 2015
x We aimed to determine clinical, laboratory and demographical characteristics of tularemia on admission to Emergency Department (ED).
ED bedside point-of-care lactate in patients with suspected sepsis is associated with reduced time to iv fluids and mortality Adam J. Singer, Maria Taylor, Debra LeBlanc, Justin Williams, Henry C. Thode Jr.
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: July 1 2014
x Early recognition and treatment of sepsis improves outcomes. We determined the effects of bedside point-of-care (POC) lactate measurement on test turnaround time, time to administration of IV fluids and antibiotics, mortality, and ICU admissions in adult ED patients with suspected sepsis. We hypothesized that bedside lactate POC testing would reduce time to IV fluids and antibiotics.
Diagnosing poststernotomy mediastinitis in the ED Jan J. van Wingerden, Mario Maas, Richard L. Braam, Bas A. de Mol
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.048
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 21 2015
x Poststernotomy mediastinitis (PSM), the severe chest wall and mediastinal infection that may arise at any time after a sternotomy, causes significant morbidity and mortality globally. Late recognition and diagnosis are the major contributors to a poor outcome. This review focuses on recent advances in diagnosing PSM (particularly after cardiovascular surgery) at the earliest opportunity—in the emergency department.
The seasonality of acute coronary syndrome and its relations with climatic parameters Yi Li, Tiekuan Du, Matthew R. Lewin, Houli Wang, Xu Ji, Yanping Zhang, Tengda Xu, Lingjie Xu, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.02.027
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: May 3 2010
x Most research on the seasonality of acute coronary syndrome (ACS) has been were reported from hospital-based data. We aimed to investigate the seasonal distribution of ACS in Beijing and to elucidate the relations between ACS occurrence and climatic parameters in a prehospital setting.
The infected heart: ventriculoseptal abscess and intracardiac fistulization Keith Habeeb, Holly Stankewicz, Jennifer Axelband, Scott Melanson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.053
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: June 29 2015
x Infective endocarditis is a rare but potentially deadly infection of the endocardial layer, which can involve the valves of the heart among other structures. The extraordinarily rare complication seen in this case involves extensive damage manifesting in an aortic root abscess resulting in an abnormal communication between the aorta and the atrium known as an aortocavitary fistula (Eur Heart J 2005;26:288-297; Pediatr Cardiol 2011;32:1057-1059; J Am Coll Cardiol 1991;18:663-667). As the disease progresses, wading through the complex symptoms, which may seem unrelated, represents a key challenge in diagnosis.
Mucormycosis: what emergency physicians need to know? Brit Long, Alex Koyfman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.037
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 25 2015
x Mucormycosis is a rare presentation for patients in the emergency department (ED), primarily affecting immunocompromised patients. Multiple forms of infection are present, and with poor prognosis, ED diagnosis and treatment of this deadly condition are necessary.
Complete resolution of a solitary pontine abscess in a patient with dental caries Ming-Hua Chen, Hung-Wen Kao, Chun-An Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: February 11 2013
x A solitary brainstem abscess is a rare fatal intracranial infection, which can be mistaken for an acute stroke complicated with a systemic infection. Dental caries without abscess formation can be a possible source of infection. Herein, we describe the case of a 59-year-old man with dental caries who presented with a 4-day history of progressive dizziness, double vision, gait ataxia, emesis, and left facial and body numbness. Fever, suboccipital headache, and difficulties in urinating and defecating were noted on admission.
Hyperacute Guillain-Barré syndrome mimicking stroke: report of 3 cases: Guillain-Barré and stroke M. de Montaudouin, O. Fleury, M. Rouanet, P. Renou, F. Rouanet, Igor Sibon
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.019
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: February 26 2014
x Stroke is the leading cause of acute neurologic deficit. However, several potentially life-threatening diseases can mimic stroke symptoms. Herein, we report 3 cases of sudden onset neurologic deficits with a final diagnosis of hyperacute Guillain-Barré syndrome. Two cases mimicked brain stem stroke, whereas the last suggested a spinal cord infarct. No specific characteristics in terms of electrophysiological parameter, underlying etiology, response to treatment, or prognosis was found between these hyperacute forms of hyperacute Guillain-Barré syndrome and more common subacute forms.
Hantavirus infection in North America: a clinical review James Hartline, Chris Mierek, Tristan Knutson, Christopher Kang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.001
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: May 15 2013
x The recent outbreak of hantavirus in Yosemite National Park has attracted national attention, with 10 confirmed cases of hantavirus cardiopulmonary syndrome and thousands of more people exposed. This article will review the epidemiology, presentation, workup, and treatment for this rare but potentially lethal illness. The possibility of infection with hantavirus deserves consideration in patients with severe respiratory symptoms with rodent exposure or rural/wilderness travel. Accurate diagnosis requires a high index of suspicion.
The use of prophylactic antibiotics in treatment of fingertip amputation: a randomized prospective trial Guy Rubin, Hagay Orbach, Micha Rinott, Alejandro Wolovelsky, Nimrod Rozen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.002
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 5 2015
x Fingertip amputation is a common injury. Considerable controversy exists as to whether prophylactic antibiotics are necessary for this injury. Our goal was to compare the rate of infections among subgroups with and without prophylactic antibiotic treatment. The study hypothesis was that infection rates were similar in the 2 groups.
Tetanus Quick Stick as an applicable and cost-effective test in assessment of immunity status Hamid Reza Hatamabadi, Ali Abdalvand, Saeed Safari, Hamid Kariman, Ali Arhami Dolatabadi, Ali Shahrami, Hossein Alimohammadi, Mostafa Hosseini
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.046
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: May 3 2010
x Tetanus vaccine and immunoglobulin administration are challenging decisions mostly because of the fact that the current protocol for immunization against tetanus is based on 2 variables: the vaccination status of the patient and the nature of wound and its exposure. To solve this problem, Tetanus Quick Stick (TQS; Nephrotek Laboratory, Rungis, France), an immunochromatographic dipstick test, was developed to determine the tetanus immunity of the patients. The aim of this present study was to investigate the sensitivity, specificity, and the positive and negative predictive values and cost-effectiveness of TQS in the emergency department (ED) setting.
Red cell distribution width is a prognostic factor in severe sepsis and septic shock You Hwan Jo, Kyuseok Kim, Jae Hyuk Lee, Changwoo Kang, Taegyun Kim, Hyun-Mi Park, Kyeong Won Kang, Joonghee Kim, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.017
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x This study was performed to investigate the association of red cell distribution width (RDW) with 28-day mortality in patients with severe sepsis and septic shock.
Spontaneous lingual abscess in an immunocompromised patient Nick Kettaneh, Kelly Williamson
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 25 2013
x Acute lingual abscess is a rare yet life-threatening clinical entity. Lingual abscess must be appropriately diagnosed and treated in the emergency department to avoid acute airway compromise. A 68-year-old woman on immunomodulatory medication for rheumatoid arthritis presented to the emergency department with left facial pain and swelling. An anterior lingual abscess was diagnosed on computed tomographic scan. The most common cause of lingual abscess is direct trauma, although immunocompromised state is a predisposing risk factor.
Case series of exercise-induced rhabdomyolysis in the New York City jail system Ross MacDonald, Zachary Rosner, Homer Venters
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.051
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: March 20 2014
x Rhabdomyolysis is a serious medical condition associated with skeletal muscle damage, potentially leading to renal failure and death. Causes of rhabdomyolysis include drugs, trauma, infection, exercise, heat, and toxins [1–3].
The relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock Faheem W. Guirgis, Deborah J. Williams, Matthew Hale, Abubakr A. Bajwa, Adil Shujaat, Nisha Patel, Colleen J. Kalynych, Alan E. Jones, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.013
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 18 2014
x Previous studies suggest a relationship between chloride-rich intravenous fluids and acute kidney injury in critically ill patients.
